Isolated C3–C4 disc herniations present as a painless myelopathy

BACKGROUND CONTEXT: Cervical disc herniations at the C3-C4 level are distinctly uncommon. The authors present the first case series of isolated C3-C4 disc herniations presenting with myelopathy. PURPOSE: To elucidate a rare presentation of the uncommon C3-C4 disc herniation. STUDY DESIGN: Case series. PATIENT SAMPLE: The four patients who presented with myelopathy caused by isolated C3-C4 disc herniations, at the spine unit, Vancouver General Hospital between 1999 and 2005. OUTCOME MEASURE: Improvement in neurological status. METHODS: We retrospectively reviewed the files of the patients. The clinical features and outcome of surgery were assessed. RESULTS: The C3-C4 disc herniation can present as with no or mild pain, and hand numbness was a prominent symptom. Early recognition and treatment led to favorable outcome. CONCLUSIONS: Myelopathy is rarely caused by a C3-C4 disc herniation. This etiology may be underdiagnosed but has a more favorable outcome in those cases where rapid diagnosis is followed by spinal cord decompression.